Optimize Acute Pain Management with Suzetrigine (Journavx)
Overview
The spotlight is on suzetrigine (Journavx), the first non-opioid analgesic approved for moderate to severe acute pain in over two decades. Block pain transmission—suzetrigine acts as a selective sodium channel blocker, preventing pain signals from reaching the central nervous system. Unlike opioids, avoid concerns about misuse, respiratory depression, or dependence, as suzetrigine is not a controlled substance.
Clinical practice
Evaluate the clinical evidence
Recognize that current efficacy data come from about 900 patients undergoing abdominoplasty or bunionectomy, primarily white women in their 40s. Compare analgesic effects—suzetrigine provides pain relief better than placebo and similar to hydrocodone/acetaminophen, but interpret cautiously due to trial limitations. Studies permitted ibuprofen use, included lower doses of opioid comparators than commonly prescribed postoperatively, and lack peer-reviewed publication.
Do not rush to use suzetrigine as a first-line agent for moderate to severe acute pain. Prioritize standard regimens—recommend oral acetaminophen 500-1,000 mg and/or ibuprofen 200-400 mg every 6 hours as needed. Reserve suzetrigine for cases where NSAIDs or acetaminophen are insufficient or contraindicated.
Dosing and administration
- Prescribe two 50 mg tablets (100 mg total) orally on an empty stomach initially, followed by one 50 mg tablet twice daily with or without food.
- Adjust dose in moderate hepatic impairment and limit duration to the shortest time necessary, as safety beyond 14 days remains unknown.
Drug interactions and precautions
- Avoid concomitant use with strong CYP3A inhibitors (itraconazole, clarithromycin) or inducers (rifampin, carbamazepine) due to altered drug metabolism.
- Recommend backup contraception (condoms, etc.) while on suzetrigine and for 28 days after discontinuation if patients use hormonal contraceptives containing progestins other than levonorgestrel or norethindrone.
Monitor for adverse effects
Educate patients about common side effects, including pruritus (itching) and muscle spasms. Advise avoiding grapefruit, which increases suzetrigine plasma levels via CYP3A4 inhibition. Stay updated on real-world use—further studies are needed to assess effectiveness in broader populations and non-surgical pain conditions.
References
- Osteen JD, Immani S, Tapley TL, et al. Pharmacology and Mechanism of Action of Suzetrigine, a Potent and Selective NaV1.8 Pain Signal Inhibitor for the Treatment of Moderate to Severe Pain. Pain Ther. Published online January 8, 2025.
- Jones J, Correll DJ, Lechner SM, et al. Selective Inhibition of NaV1.8 with VX-548 for Acute Pain. N Engl J Med. 2023;389(5):393-405.
- Rind DM, McQueen B, Nikitin D, et al. Suzetrigine for Acute Pain; Evidence Report. Institute for Clinical and Economic Review, February 5, 2025. https://icer.org/assessment/acute-pain-2025.
